Gynecomastia (Male Breast Enlargement): Overview

Gynecomastia

Gynecomastia is enlargement of the gland tissue of the male breast. During infancy, puberty and in middle-aged to older men, gynecomastia can be common. It must be distinguished from lipomastia, which refers to the presence of the fat deposits in the breast area of overweight or obese men. True gynecomastia results from growth of the glandular, or breast tissue, which is present in a very small amounts in men. It is the most common reason for medical evaluation of the male breast. 

Causes

Androgens are hormones that create characteristics of a male, such as hair growth, muscle size, and a deep voice. While estrogens are hormones that create female characteristics. All men have both. 

Changes in the levels of these hormones, or in how the body uses or responds to these hormones can cause enlarged breasts in men. 

More than half of boys develop gynecomastia during puberty. 

Other causes include:

  • Aging
  • Cancer chemotherapy
  • Chronic liver disease
  • Exposure to anabolic steroid hormones
  • Exposure to estrogen hormone
  • Kidney failure and dialysis
  • Lack (deficiency) of testosterone (male hormone)
  • Marijuana use
  • Hormone treatment for prostate cancer
  • Radiation treatment of the testicles
  • Side effects of some medications such as ketoconazole, spironolactone, metronidazole, cimetidine (Tagamet)

Symptoms

The classic feature of gynecomastia is male breast enlargement with rubbery or firm glandular subcutaneous chest tissue palpated under the areola of the nipple in contrast to softer fatty tissue. This enlargement may occur on one side or both.  Milky discharge from the nipple is not a typical finding, but may be seen in a gynecomastic individual with a prolactin secreting tumor. Males with gynecomastia may appear anxious or stressed due to concerns about the possibility of having a breast cancer. An increase in the diameter of the areola and asymmetry of chest tissue are other possible signs of gynecomastia.

 See your doctor if you have:

  • Swelling
  • Pain
  • Tenderness
  • Nipple discharge in one or both breasts

Home Care Tips

Apply cold compresses and use pain relievers such as analgesics as your health care provider recommends if swollen breasts are also tender.

Other tips include:

  • Stop taking all recreational drugs, such as marijuana
  • Stop taking all nutritional supplements or any drugs you are taking for bodybuilding

Treatment

Gynecomastia, especially in pubertal males, often goes away on its own within about six months, so observation is preferred over specific treatment in many cases. Stopping any offending medications and treatment of underlying medical conditions that causes this condition are also mainstays of treatment. 

Treatments are also available to specifically address the problem of gynecomastia, but data on their effectiveness are limited, and no drugs have yet been approved by the U.S. Food and Drug Administration (FDA) for treatment. Medications are more effective in reducing gynecomastia in the early stages, since scarring often occurs after about 12 months. After the tissue has become scarred, medications are not likely to be effective, and surgical removal is the only possible treatment. 

Surgical Treatments

Reduction mammoplasty (breast reduction surgery) has been used in cases of severe gynecomastia, long-term gynecomastia, or in cases in which drug therapies have not been effective.

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